At the 2019 Annual Meeting of the American Academy of Orthopedic Surgeons (AAOS) held in Las Vegas in March, clinical researchers presented a pair of studies that provided exciting new insights into the power of Reflexion Health’s Virtual Exercise Rehabilitation Assistant (VERA™) telerehab platform to transform the process of post-surgical rehab.
As President and CEO of Reflexion Health Dr. Joseph Smith recently told Outcomes Rocket Podcast’s Saul Marquez, the benefits demonstrated by these studies, represents a “win-win-win” offering benefits for patients, providers and payors alike — and, thus, the industry as a whole.
“It truly is value based, which is what we need in our healthcare system,” he said.
Achieving Post-Acute Cost Savings with ‘No Increase in Readmissions’
That importance of that sentiment was borne out repeatedly at the AAOS Annual Meeting, where researchers from Yale New Haven Health and the Duke Clinical Research Institute (DCRI) presented a pair of landmark clinical results both centered around VERA and its ability to enhance efficiencies, reduce costs and boost patient satisfaction.
As described in a news release issued by the AAOS, the Yale study, presented under the title “Tele-rehabilitation for Total Hip and Knee Arthroplasty Patients: No Increase in Readmissions,” demonstrated that offering total hip and knee replacement patients the chance to undergo telerehab with VERA “was found to lower costs, increase patient compliance” and deliver “high patient satisfaction.”
The study traced the progress of 40 patients who utilized VERA to recover from total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures. When compared to the results of 614 patients who underwent standard home or outpatient physical therapy, the findings showed that:
The VERA patients “had high rates of accuracy in performing exercises”
None of the TKA telerehab patients “required manipulation, which is often used to treat knee stiffness following surgery”
Patient satisfaction with the use of VERA “was very high, with an approval score of 91.2 percent”
The study also found that “30 day and 90-day readmission rates were not significantly different” between the groups, and there was “a near identical rate of emergency department visits at 90 days.” But perhaps most strikingly, cost analysis from revealed that patients in the VERA telerehab group “showed a minimum cost savings of $1,000 when tele-rehabilitation was utilized,” the AAOS release states.1
‘With Guidance and Support through Tele-rehabilitation, You Are Going to Lower Your Cost’
In her assessment of these findings, Mary I. O'Connor, MD, FAOA, FAAHKS, FAAOS, Director, Center for Musculoskeletal Care, Professor of Orthopaedics and Rehabilitation, Yale School of Medicine, emphasizes this potential for cost savings.
“Physical therapy with a physical therapist is a resource-heavy model,” she said. “Any time you involve a skilled professional, as a physical therapist is, it is going to increase your cost. When the patient can do routine exercises on their own with guidance and support through tele-rehabilitation, you are going to lower your cost.”
Yet Dr. O’Connor also emphasizes that this model of at-home rehab “doesn't eliminate the need for [a] skilled physical therapist.” Rather it’s “an extender of physical therapy” — an important distinction for providers who may be reluctant to embrace virtual PT out of a sense that it’s designed to replace them. On the contrary, as Dr. Smith explained to Marquez, the VERA model of telerehab is actually designed to assist clinicians.
By offering an intuitive dashboard for remote clinical review and automatic report generation while documenting precisely “just what's going on,” VERA expands “the capacity of the average practitioner to be able to integrate that information and apply it to the next patient that they see,” he said.
“Clinicians get to observe kind of an unprecedented amount of information,” he added, “because the way we've built the technology, it images the patient, it does skeletal reconstruction and estimates joint angles and limb velocities at 30 times a second, and runs that up against algorithms for the appropriate ways they should be moving.”
“One of the strengths of this system is that you actually know if the patient is doing therapy,” Dr. O’Connor adds in the AAOS news release. “Unlike before, I know if a patient has logged on and done their exercises. Another nice feature is that the physical therapist can interact live with the patient. It is another opportunity to have a higher-quality touchpoint with the patient without the patient having to come into the office.”
Lead DCRI Researcher Calls for ‘Reimbursement for Therapist-Led Telerehabilitation’
Also at the 2019 AAOS Annual Meeting, Janet Prvu Bettger, Ph.D., associate professor with the Duke Department of Orthopedic Surgery and principal investigator of the Virtual Exercise Rehabilitation In-home Therapy: A Research Study (VERITAS), presented the findings from the first large-scale randomized controlled clinical trial comparing virtual to traditional physical therapy.
Formally conducted by the DCRI, the world’s largest academic research organization, the VERITAS study concluded that the Reflexion Health VERA telerehab platform, when delivered with appropriate clinical oversight, is as safe and effective as traditional physical therapy. On top of that, researchers estimated that the use of VERA can save payors and providers $2,745 per patient in a bundled-payment setting.2
Described as a “multi-center, randomized controlled trial,” VERITAS involved the enrollment of 306 adult participants scheduled for TKR surgery at four sites across the United States, with 287 completing the trial. Of those, 143 participants used VERA during both pre- and post-surgery, while the control group of 144 patients received traditional in-home and/or clinic-based physical therapy. Outcomes, service use and overall costs were examined for three months following surgery.
“We are pleased with the results of the study which show that Reflexion Health’s VERA coupled with remote clinician oversight, is a cost-effective paradigm for physical therapy – one that is more convenient for patients while providing clinicians greater insight into the recovery process,” as Dr. Bettger concluded in a news release.
“Now we need reimbursement for therapist-led telerehabilitation to support uptake,” she added in a Tweet from AAOS.
Excited to attend my first #AAOS2019 and present findings from our #virtual #exercise #rehabilitation RCT for total knee arthroplasty patients— Janet Prvu Bettger (@jpbettger) March 14, 2019
Now we need reimbursement for therapist-led telerehabilitation to support uptake@DukeOrtho @DCRINews @dukemargolis @ReflexionHealth pic.twitter.com/0DRfUvHmXv
‘I Can Do My Exercises in My Housecoat’
As Dr. Smith pointed out to Marquez, the DCRI VERITAS study was groundbreaking for a number of reasons — not just for being the first large-scale randomized controlled study comparing virtual to traditional PT, but also for its demonstration that digital healthcare startups can achieve validation by undergoing the clinical validation process.
“I really value quantitative information and proof of value,” he said. “And so, for us, to distinguish ourselves [and] know that we're working with something that can truly matter … We bit the bullet and did an arms-length, prospective randomized controlled trial comparing this notion of virtual physical therapy, virtual recovery at home, with the standard of care, with what people are typically used to getting.”
The results are “gratifying,” Dr. Smith said: “They show that, you know, not only are the clinical outcomes as good or better than routine, kind of face-to-face therapy, but it also happens in a way that the patients love — we get Net Promoter Scores that are better than Apple products and Amazon services, and also with a tremendous savings to the healthcare system.”
The Yale study also emphasizes VERA’s “world-class” NPS ranking, and patient satisfaction in general: “We have been very pleased with our experience to date, particularly the very high level of patient satisfaction,” Dr. O’Connor stated.
“An elderly knee replacement patient of mine told me how much she loved VERA. I asked her why and her response surprised me,” she continued. “She said: 'Dr. O'Connor, I don't have to make sure my house is clean, or my hair is done and I have makeup on as when the physical therapist comes to the house. I can do my exercises in my housecoat.’”
Value-Added Care with a Patient-Centric Focus
Ultimately, as Dr. Smith emphasizes, as important as it is to offer a value-added model of care that benefits payors and providers, it’s this patient-centric approach that truly defines Reflexion Health’s mission in general, and VERA’s appeal in the specific.
“We would ask people who are trying to recover to come back and forth to a clinician's office for physical therapy, or we would at times have physical therapists visit them in the home, which is a similarly awkward circumstance for many, when there's technology that's readily available that can educate and monitor and coach and reward patients to do their therapy in the safety and comfort of their own home,” he told Marquez.
“Hearing from patients that they got better so much faster than they thought, or hearing from a husband who's changed where he's going to get his surgery done so that he can take advantage of this more convenient way of getting his rehabilitation accomplished — all of that feels just terrific,” he adds.
“On par with that is hearing from employees about how they feel like they're really making a difference,” he continues. “They hear these stories and it gives them real meaning and purpose to be able to know that at the other end of their technology, they're actually helping somebody work with a medical challenge. That feels terrific.”
O’Connor MI, Moore AR, Rubin LE. Tele-Rehabilitation for Total Hip and Knee Arthroplasty Patients: No Increase in Readmissions (Paper 850). Presented at the 2019 Annual Meeting of the American Academy of Orthopaedic Surgeons, March 12-16, Las Vegas, Nevada.
Bettger, Janet Prvu et al. VERITAS: Effect of Virtual Exercise Rehabilitation In-home Physical Therapy versus Traditional Care for Total Knee Arthroplasty. Poster presented at ACRM Annual Conference; 2018 Sept 30-Oct 3; Dallas TX.